Video-assisted hepatic abscess debridement

Dear Editor,

I read with interest the article from our colleagues from Maastricht and Aachen, which describes a video-assisted approach to debridement of multi-loculated or so-called “honey-comb” liver abscesses,¹ which are notoriously difficult to treat by simple percutaneous drainage alone.

The article describes access via an open flank incision, with subsequent debridement facilitated by the insertion of a laparoscope through the incision. This is a technique synonymous with an approach to video-assisted pancreatic necrosectomy, popularised predominantly by groups from the Netherlands.

I would like to report similar success in treating these abscesses via a percutaneous approach – again reported previously for the treatment of infected pancreatic necrosis.² For this approach, I have used a balloon dilator to enlarge the tract of a percutaneous pig-tail drain and performed a debridement via the drain tract using a nephroscope. This alternative technique has the advantage of producing only a 24F drain tract wound, which carries far less morbidity than an open flank incision and simplifies the subsequent management of any potential biliary fistula. A speedy resolution of the abscess following debridement was achieved (Fig. 1).

Figure 1.

CT Scans showing response to percutaneous debridement of large multi-loculated liver abscess using a drain-tract approach